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The effects of oral cyclosporine in plaque-type psoriasis: the experience of Andreas Sygros Hospital

Antoniou C, Stratigos A, Stefanaki C, Stavropoulos P, Potouridou I, Katsambas AD and Avgerinou G

Introduction: Several studies have shown the efficacy of cyclosporine in the treatment of chronic plaque-type psoriasis. Aim: The aim of this retrospective study was to assess the clinical response and toxicity of cyclosporine in a small cohort of patients with refractory plaque-type psoriasis. Methods: A total of 39 patients, including 25 males (64%) and 14 females (36%), with mild-to-severe plaque-type psoriasis were included in this retrospective, chart-based study. Treatment consisted of cyclosporine at a dose of 1.5–5.0 mg/kg/day (mean dose of 2.53 mg/kg/day). The mean duration of therapy was 31.0 weeks (range of 3– 227 weeks). Main outcome measures: The main outcome measures were the physician’s global assessment and the psoriasis area and severity index (PASI). Results: Satisfactory clinical response, defined as significant improvement, based on the physician’s global assessment, was observed in 31 patients (79.9%). Disease remission was observed in 26 (66.7%) and 29 patients (74.4%), with a reduction in PASI score by 80% and 50% respectively. The mean PASI score decreased by 96% from 12.7 (range of 1–39) at the beginning of treatment to 0.5 (range 0–5) at the end of treatment. Disease recurrence, defined as an increase of PASI score by 50%, was observed in 19 patients (73.1%). The median time-to-relapse was 105 days, according to the Kaplan–Meier curves. No statistically significant change in the arterial blood pressure and serum creatinine levels were noted during treatment (paired t-test, p = 0,556). In five cases (12.8%), there was an increase in creatinine levels by more than 30%. Conclusion: Treatment with cyclosporine is well tolerated and provides an effective modality for the control of plaque-type psoriasis. Psoriasis is a chronic cutaneous disease that can seriously affect a patient’s psychologic status and quality of life. To control the disease, life-long intermittent treatment is required. Various treatment modalities have been employed to achieve this goal. Mild forms of the disease are usually treated with topical agents, such as topical steroids, calcipotriol (Dovonex®, Leo Laboratories) tar, or dithranol. In more extensive forms of the disease, phototherapy/ultraviolet (UV)B and long-wave ultraviolet radiation photochemotherapy (PUVA) or systemic therapy are considered. Systemic therapies,